Whooping cough still packs a potentially deadly wallop

November 11, 1999

LOS ANGELES (Nov. 12, 1999) - It is supposed to be a problem of the past, vanquished by vaccines that have been available since the 1940s. But whooping cough, or pertussis, still strikes as many as 120,000 people each year, causing serious complications and even death, especially among its youngest victims.

Part of the problem is that some parents remain reluctant to have their children vaccinated. The vaccine that was first introduced often caused fever and fussiness, and occasionally more serious reactions, but the newer form is much safer, according to Deborah Lehman, M.D., a specialist in pediatric infectious diseases at Cedars-Sinai Medical Center.

"With the introduction of acellular vaccine in 1991, there was a huge reduction in the number of side effects, but pertussis vaccine already had a bad reputation from the whole-cell vaccine that had been used for so many years before," says Dr. Lehman. "Many people still are not aware of the newer vaccine. But the risk with either vaccine is far better than the risks associated with pertussis."

Pertussis bacteria invade the throat, windpipes and lungs, creating a large amount of mucous. Infected adults usually experience a hacking cough that persists for weeks or months. But children -- especially those less than a year in age -- can develop violent, prolonged coughing spells.

"These kids can't catch their breath, can't get air in. If they can't get enough oxygen to the brain, they may have seizures and brain damage," says Dr. Lehman, who recently treated two sisters whose coughing and clogged airways made them vulnerable to such neurologic damage.

The girls, who had not been vaccinated, acquired the bacteria from an adult family member whose persistent cough was later diagnosed as pertussis. The toddlers were hospitalized for about five days while they were given oxygen and antibiotics.

Dr. Lehman says that although many adults were vaccinated when they were children, immunity eventually declines. And while symptoms in adults are generally little more than a nuisance, the bacteria they are harboring are easily spread in the air by coughing and sneezing.

"Adults are the major reservoir for the bacteria that infect children. Studies are currently being conducted to determine if we should vaccinate adults or give them boosters for pertussis, not only to protect them from the irritating cough, but to keep them from spreading the bacteria to their young family members," according to Dr. Lehman, associate director of pediatric infectious diseases at Cedars-Sinai.

The number of reported cases of whooping cough has declined markedly since immunization began, when were 150,000 to 250,000 cases a year. Today, the Centers for Disease Control and Prevention (CDC) says 14,000 cases are reported each year, but investigators estimate the actual incidence to be closer to 120,000.

"It is a disease that must be reported but it isn't always easy to make a diagnosis, and clinicians don't always think of it, especially in adults. Because it is not considered an adult disease, a family member may be coughing and coughing for months and no one will think of pertussis," says Dr. Lehman. The only way to accurately diagnose the disease is to send a sample of mucous to a lab that is capable of performing the specialized test.

The whooping cough vaccine is one component of the common childhood immunization referred to as DTaP: diphtheria, tetanus, acellular pertussis. The shots are given at 2 months, 4 months and 6 months of age, followed by a booster between 12 and 18 months. Another immunization is given before children go to kindergarten.

Although some parents object to having their children immunized, these kids are actually protected from certain diseases through 'herd immunity,' says Dr. Lehman. Because everyone around them is immunized, eliminating such diseases as measles and polio, for example, even children who are not vaccinated are safe.

"Pertussis, on the other hand, is not eliminated. Even though incidence is definitely lower than it was prior to vaccinations, pertussis is prevalent in the adult population, putting kids at risk," says Dr. Lehman. "I think people who do not vaccinate their kids have a false sense of security that their kids are OK as long as everyone else takes the risk of vaccination. Truthfully, that's not the case for things like pertussis and tetanus."
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Cedars-Sinai Medical Center

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